Behavioral Health Parity - New Rules for Enforcement

The United States Departments of Labor, Health and Human Services, and Treasury have established new rules to strengthen their commitment to ensuring equitable access to mental health and substance use disorder care. These rules build upon the Mental Health Parity and Addiction Equity Act (MHPAEA), which requires insurers to cover behavioral healthcare and medical and surgical care equally, without imposing additional restrictions on the former. The final rules also prohibit plans from using biased information and sources that might negatively impact access to behavioral healthcare when designing and applying a nonquantitative treatment limitation, which limits the scope or duration of benefits (e.g., step therapy, prior authorization, or standards of provider network participation).  

While the MHPAEA was first implemented in 2008, many individuals in the US have continued to face barriers to accessing behavioral healthcare. The new rules will implement additional protections against nonquantitative treatment limitations; insurance issuers are required to collect and evaluate data on behavioral health-related nonquantitative treatment limitations and adjust if they are insufficient. To encourage implementation of parity in Medicaid and the Children’s Health Insurance Program (CHIP), the Centers for Medicare & Medicaid Services (CMS) have developed a set of templates and instructional guides to help state agencies document compliance with MHPAEA requirements in their Medicaid managed care programs, Medicaid alternative benefit plans, and CHIP. These new tools are designed to standardize, streamline, and strengthen documentation and review processes to ensure that all beneficiaries have access to appropriate mental health and substance use disorder services.

Providers wishing to understand how the new rules impact them should refer to the US Department of Labor one-pager. To learn more about the final rules, see the Final Rules under the MHPAEA Fact Sheet.  CMS is issuing requests for public comment on the Medicaid and CHIP parity compliance tools at Medicaid.gov. For further reading about the MHPAEA and parity, see the Academy’s Literature Collection.